结直肠腺瘤上皮内瘤变高危因素657例分析

Risk factors for intraepithelial neoplasia in patients with colorectal adenoma

目的分析结直肠腺瘤临床、内镜及病理组织学特点,总结结直肠腺瘤发生上皮内瘤变的相关危险因素.方法回顾分析华中科技大学同济医学院附属协和医院2014-01/2016-04以电子结肠镜检出并经病理证实为结直肠腺瘤性息肉的657例患者的相关临床资料,依据是否存在上皮内瘤变分为上皮内瘤变组和非上皮内瘤变组,组间采用χ~2检验,腺瘤发生上皮内瘤变及其恶变程度的相关危险因素采用多因素Logistic回归分析.结果结直肠腺瘤多发生于左半结肠,上皮内瘤变总发生率为22.68%,年龄、息肉直径、蒂的长度、病理类型是腺瘤上皮内瘤变的危险因素,可纳入Logistic回归方程:logit P=-4.384+0.796X2(年龄)+0.324X3(息肉直径)+1.296X4(蒂部形态)+0.944X7(病理类型).性别、年龄、息肉大小是腺瘤高级别内瘤变的危险因素,可纳入Logistic回归方程:logit P=-2.939+1.036X1(性别)+0.853X2(年龄)+1.023X3(息肉直径).低级别及高级别上皮内瘤变组总胆固醇、甘油三酯水平均显著高于无上皮内瘤变组(P<0.05).高级别上皮瘤变组在低密度脂蛋白、尿酸(uric acid,URIC)均显著高于无上皮内瘤变组(P<0.05).而三组之间高密度脂蛋白、癌胚抗原无明显差异.结论年龄>40岁、直径>1 cm、有蒂及绒毛管状腺瘤更易发生上皮内瘤变,男性、息肉直径、年龄是结直肠腺瘤发生高级别上皮内瘤变的危险因素.结直肠腺瘤发生上皮内瘤变可能与血脂、URIC水平有关.

AIM To identify risk factors for intraepithelial neoplasia in colorectal adenoma by analyzing the clinical, endoscopic, and histopathological features of patients with colorectal adenoma. METHODS The clinical, endoscopic, and histopathological features of 657 patients with colorectal adenomatous polyps diagnosed by colonoscopy from January 2014 to April 2016 at Wuhan Union Hospital were retrospectively analyzed. The patients were divided into an intraepithelial neoplasia group and a non-intraepithelial neoplasia group according to the pathological diagnosis. 2 test was applied for univariate analysis between the two groups. Multivariate Logistic regression analysis was used to identify the risk factors for intraepithelial neoplasia and its malignancy degree in adenoma. RESULTS Most of colorectal adenomas were located in the left colon. The total incidence of intraepithelial neoplasia in colorectal adenoma was 22.68%. Age, polyp diameter, length of pedicle, and pathologic type were identified to be risk factors for intraepithelial neoplasia in adenoma, which could be incorporated in Logistic regression equation： logit P = -4.384 ± 0.796χ2 （age） ＋ 0.324X3 （polyp diameter） ＋ 1.296X4 （pedicle condition） ＋ 0.944X7 （pathology type）. Gender, age, and polyp size were identified to be risk factors for high- grade intraepithelial neoplasia in adenoma, whichcould be incorporated in Logistic regression equation： logit P = -2.939 ＋ 1.036X1 （gender） ＋ 0.853χ2 （age） ＋ 1.023X3 （polyp diameter）. Total cholesterol （TC） and triglyceride （TG） in the low-grade and high-grade intraepithelial neoplasia groups were both significantly higher than those in the non-intraepithelial neoplasia group （P 〈 0.05）. Low-density lipoprotein cholesterol （LDL-C） and uric acid （URIC） in the high-grade intraepithelial neoplasia group were both significantly higher than those in the non-intraepithelial neoplasia group （P 〈 0.05）. There was no significant difference in the high-density lipoprotein cholesterol （HDL-C） or CEA among the three groups. CONCLUSION There is a greater risk of intraepithelial neoplasia among patients older than 40, having villous adenoma with diameter 〉 1 cm and pedicle. Male, polyp diameter, and age are risk factors for high-grade intraepithelial neoplasia in colorectal adenoma. The occurrence of intraepithelial neoplasia in adenoma may be related to blood lipids and uric acid levels.